Maine, assisted suicide, and freedom of conscience

Accommodation of objecting physicians convoluted and unsatisfactory

Sean Murphy*

Introduction

Maine’s Death with Dignity Act1 was signed by the state governor on 12 June, 2019,2 to take effect on 18 September.  By the last week in August, physicians in the state were deeply divided and significant institutional health care providers were expected to opt out.3

In reviewing the Act, the Project focus is on sections relevant to the protection of those who refuse to provide or facilitate suicide for reasons of conscience.  These are convoluted and unsatisfactory.  In brief, the Act

  • imposes obligations on physicians that may be unacceptable to those who unwilling to facilitate assisted suicide,
  •  provides insufficient protection for objecting physicians not employed or by or under contract with an objecting institution,
  •  limits the ability of objecting health care facilities to maintain institutional integrity. . . [Full text]

New Jersey assisted suicide law and freedom of conscience

Lack of clarity on referral  is unsatisfactory

Sean Murphy*

Overview

New Jersey’s Medical Aid in Dying for the Terminally Ill Act1 came into effect on 1 August, 2019.2

The Act permits physician assisted suicide for any resident of New Jersey who is 18 years of age or over, who can make and communicate informed health care decisions, who has been diagnosed with a terminal illness and who is likely to die within six months. Physicians assist by providing a prescription for lethal medication.  The patient must make two oral requests for the medication 15 days apart, and a written request.  Two physicians must agree that the patient is decisionally competent and meets the medical criteria.  Additional consultation is required if there is concern about psychological or psychiatric conditions that may impair a patient’s judgement.  . .[Full text]

Court reinstates lawsuit against Catholic hospital for refusing transgender patient’s surgery

Los Angeles Times

Michael Hiltzik

Stating that California’s interest in fighting discrimination against LGBTQ residents outweighs the right to impose religious standards on healthcare, an appeals court has reinstated a lawsuit against the Catholic Dignity Health hospital chain for barring a hysterectomy for a transgender patient.

The lawsuit was brought by Evan Minton, whose hysterectomy was abruptly canceled by Dignity’s Mercy San Juan Medical Center of Carmichael, Calif., in 2016 when hospital officials learned he was transgender. The hospital took the action to comply with the church’s Ethical and Religious Directives for Catholic Health Care Services, which prohibit sterilization procedures except in very narrow circumstances. . . [Full text]

USCCB Poll: Americans Support Conscience Protection for Healthcare Professionals

News Release

US Conference of Catholic Bishops

September 18, 2019

WASHINGTON, D.C. – Two new polls have revealed widespread discrimination against healthcare workers of faith, as well as broad public support for conscience rights laws and protections. The findings were released today by the United States Conference of Catholic Bishops (USCCB) Committees on Pro-Life Activities; Religious Liberty; Domestic and Social Development; and the Subcommittee for the Promotion and Defense of Marriage, as well as the Christian Medical & Dental Associations (CMDA), the largest faith-based association for healthcare professionals.
 
The findings come in the wake of enforcement actions taken by the U.S. Department of Health and Human Services (HHS) against the University of Vermont Medical Center, which is alleged to have coerced a nurse into participating in an abortion against her beliefs.

Archbishop Joseph F. Naumann, of Kansas City in Kansas and Chairman of the Committee on Pro-Life Activities; Bishop Robert J. McManus, of Worcester and Chairman of the Committee for Religious Liberty; Bishop Frank J. Dewane, of Venice, and Chairman of the Committee on Domestic Justice and Human Development, and Bishop James D. Conley, of Lincoln and Chairman of the Subcommittee for Promotion and Defense of Marriage offered the following statement on the findings:

“An overwhelming majority of Americans agree: no healthcare professional should be forced to violate deeply-held beliefs in order to keep a job. The practice of medicine depends on those courageous and generous enough to serve all people—especially the poor and marginalized—with the highest ethical standards. If we exclude people of faith from the medical profession, Americans will suffer, especially those most in need.”

For more information, click here: http://www.usccb.org/about/pro-life-activities/conscience-protection-teleconference.cfm

Media Contact:
Chieko Noguchi
202-541-3200

Christian Medical & Dental Associations reveal national survey findings on healthcare and conscience

News Release

Christian Medical & Dental Associations

Washington, D.C., September 18, 2019 — The Christian Medical & Dental Associations (CMDA ), the nation’s largest faith-based association of health professionals, today released findings of a national survey showing that conscience-protecting laws and regulations help protect patient access to health care while addressing rampant discrimination against faith-based health professionals.

The survey, a nationwide poll of faith-based health professionals, conducted by Heart and Mind Strategies, LLC, found that 91 percent said they would have to “stop practicing medicine altogether than be forced to violate my conscience.” That finding holds significant implications for millions of patients, especially the poor and those in underserved regions who depend upon faith-based health facilities and professionals for their care.

The survey of faith-based health professionals also found that virtually all care for patients “regardless of sexual orientation, gender identification, or family makeup, with sensitivity and compassion, even when I cannot validate their choices.” The finding puts the lie to the charge that somehow conscience protections will result in whole classes of patients being denied care.

“Faith-based health professionals actually seek out and serve marginalized patients to provide compassionate care, ” explained CM D A CEO Emeritus Dr. David Stevens. “All we ask as we serve is that the government not intrude into the physician-patient relationship by dictating that we must do controversial procedures and prescriptions that counter our best medical judgment or religious beliefs .”

CM DA is currently represented by the Becket law firm in two related cases: Franciscan Alliance v. Azar , which addresses an Affordable Care Act transgender mandate, and New York v. HHS, which addresses a new federal conscience protection rule.

Detail on the poll of faith-based professionals can be found at CMDA-Poll and Freedom2Care.org

The Role of Nurses When Patients Decide to End Their Lives

Some hospitals and hospices have policies that forbid nurses to be part of the process or even to discuss end-of-life options.

New York Times

Emilie Le Beau Lucchesi

When Ben Wald, 75, was dying of cancer in 2012, he wanted to use Oregon’s Death with Dignity Act to receive a prescription for a lethal medication that would end his life. His hospice nurse, Linda, was part of the discussion and provided both information and support, said his wife, Pam Wald, of Kings Valley, Ore.

His colon cancer had spread to his lungs, and his weight dropped from 180 to 118 pounds. He struggled to speak or eat.

When he was ready to end his life, the couple wanted Linda with them, but the hospice organization she worked for did not allow it, Mrs. Wald said. The organization allowed other hospice workers, such as social workers and massage therapists, to be present, but not the doctors or nurses it employed. . . [Full text]

Doctor Fired after Suing Catholic Hospital over Assisted Suicide

National Review

Wesley J. Smith

Colorado doctor Barbara Morris wants to assist her patient’s suicide. She works at Centura Health, a Catholic/Seventh Day Adventist-owned hospital that prohibits its employees from participating in assisted suicide, legal in Colorado.

Morris sued to be allowed to participate in her patient’s suicide by doctor — which would not happen in the hospital. The hospital responded by firing Morris for violating the terms of her contract by seeking to engage in acts in the context of her employment that violate the hospital’s religiously based moral beliefs.

Morris contends she can’t be prohibited from assisting her patient’s suicide because the Colorado law only allows health care facilities to opt-out if the suicide will occur on-site. The hospital is seeking shelter in the Trump administration’s medical conscience protection policies.

Expect more of these kinds of disputes as many U.S. hospitals are Catholic or otherwise religiously affiliated with churches that reject abortion and assisted suicide doctrinally. From the Kaiser Health News story:

More doctors and patients in the country are providing and receiving health care subject to religious restrictions. About 1 in 6 acute care beds nationally is in a hospital that is Catholic-owned or -affiliated, said Lois Uttley, a program director for the consumer advocacy group Community Catalyst. In Colorado, one-third of the state’s hospitals operate under Catholic guidelines.

The ACLU has already sued several Catholic hospitals over the last few years seeking to force them to violate Church doctrine on issues ranging from sterilization, to abortion, to sex-change surgeries.

Medical conscience disputes are going to become far more common as health care becomes immersed in our accelerating cultural conflicts and vexing questions of federalism. Bottom line: The ultimate goal of those who seek to force medical professionals and institutions to violate their religious beliefs, I believe, is to drive pro-lifers and Hippocratic Oath-adherents out of medicine.

Firing Doctor, Christian Hospital Sets Off National Challenge To Aid-In-Dying Laws

Kaiser Health News

JoNel  Aleccia

DENVER — A Christian-run health system in Colorado has fired a veteran doctor who went to court to fight for the right of her patient to use the state’s medical aid-in-dying law, citing religious doctrine that describes “assisted suicide” as “intrinsically evil.”

Centura Health Corp. this week abruptly terminated Dr. Barbara Morris, 65, a geriatrician with 40 years of experience, who had planned to help her patient, Cornelius “Neil” Mahoney, 64, end his life at his home. Mahoney, who has terminal cancer, is eligible to use the state’s law, overwhelmingly approved by Colorado voters in 2016.

The growing number of state aid-in-dying provisions are increasingly coming into conflict with the precepts of faith-based hospitals, which oppose the practice on religious grounds. . . [Full text]

After Months In A Dish, Lab-Grown Minibrains Start Making ‘Brain Waves’

National Public Radio

Jon Hamilton

By the time a fetus is 6 months old, it is producing electrical signals recognizable as brain waves.

And clusters of lab-grown human brain cells known as organoids seem to follow a similar schedule, researchers reported Thursday in the journal Cell Stem Cell.

“After these organoids are in that six-to-nine-months range, that’s when [the electrical patterns] start to look a lot like what you’d see with a preterm infant,” says Alysson Muotri, director of the stem cell program at the University of California, San Diego. . . [Full text]

OCR Issues Notice of Violation to the University of Vermont Medical Center After It Unlawfully Forced a Nurse to Assist in Abortion

News Release
For immediate release

US Department of Health and Human Services

Contact: HHS Press Office
202-690-6343
media@hhs.gov

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) is announcing that, after a thorough investigation and prolonged attempts to resolve the matter, OCR has issued a Notice of Violation letter finding that the University of Vermont Medical Center (UVMMC) violated the Church Amendments (42 U.S.C. 300a-7) by forcing a nurse to assist in an elective abortion procedure over the nurse’s conscience-based objections. OCR also found that UVMMC has discriminatory policies that assign or require employees to assist abortion procedures even after they have recorded their religious or moral objections to assisting in the performance of such abortions. OCR’s Notice of Violation letter asks UVMMC to conform its policies to the Church Amendments and take other corrective action, or face potential action by the HHS component from which UVMMC has received federal funding.

On May 9, 2018, a nurse at UVMMC filed a conscience and religious discrimination complaint with OCR against UVMMC, a medical center in Burlington, Vermont that receives HHS funds, contending that the nurse was forced to assist an abortion in violation of the nurse’s conscience rights. As part of its investigation, OCR contacted UVMMC repeatedly in a good faith effort to seek cooperation from UVMMC, but the hospital refused to conform its policies to federal conscience laws, provide all the documents requested by OCR, or produce witnesses for OCR interviews. Nevertheless, OCR interviewed multiple witnesses and gathered evidence concerning the allegations.

As a result of its investigation, OCR has specifically determined that:

  • UVMMC forced the nurse complainant to assist in an abortion against the nurse’s religious or moral objection. The nurse had expressed an objection for many years and was included in a list of objectors, but UVMMC knowingly assigned the nurse to an abortion procedure. The nurse was not told the procedure was an abortion until the nurse walked into the room, when the doctor—knowing the nurse objected to assisting in abortions—told the nurse, “Don’t hate me.” The nurse again objected, and other staff were present who could have taken the nurse’s place, but the nurse was required to assist with the abortion anyway. If the nurse had not done so, the nurse reasonably feared UVMMC would fire or report the nurse to licensing authorities.
  • OCR spoke with several other UVMMC health care personnel who, since at least the spring of 2017, have been intentionally, unnecessarily, and knowingly scheduled by UVMMC to assist with elective abortions against their religious or moral objections. Such personnel were often not told in advance that the procedures they were being assigned to assist with were abortions. Health care personnel who are coerced in that way suffer moral injury, are subjected to a crisis of conscience, and frequently experience significant emotional distress, even if they succeed in declining to assist in the procedure after the assignment is made.
  • UVMMC maintains a staffing policy that facially violates the Church Amendments because the policy admits to circumstances where UVMMC can and will force staff—on pain of adverse action or discipline—to participate in abortions against their moral or religious objections. The policy also violates UVMMC’s agreement, as a condition of receiving HHS funds, to comply with federal law, including the Church Amendments and HHS’s grants regulations.
  • Consequently, UVMMC is violating 42 U.S.C. § 300a-7(c)(1) of the Church Amendments by discriminating against health-care personnel who have religious or moral objections to abortion, and subjecting them to different terms or conditions of employment than other health-care personnel.

In the Notice of Violation, OCR asks that UVMMC notify OCR within thirty days whether UVMMC intends to work collaboratively with OCR to change its policies so it no longer requires health care personnel to participate in abortion against their religious or moral objections, and to take immediate steps to remedy the effect of its past discriminatory conduct. Otherwise, OCR indicates that it will forward the Notice to the Health Resources and Services Administration (HRSA), a component of HHS that provides grant funds to UVMMC, for consideration and possible additional procedures concerning UVMMC’s receipt of federal funds.  Since October 1998, UVMMC has received—and continues to receive—grants from HRSA.  For the most recently completed three-year project period, which ended April 30, 2018, UVMMC reported that it cumulatively expended $1.6 million of federal financial assistance.

Roger Severino, Director of OCR said, “Forcing medical staff to assist in the taking of human life inflicts a moral injury on them that is not only unnecessary and wrong, it violates longstanding federal law. Our investigation has uncovered serious discrimination by UVMMC against nurses and staff who cannot, in good conscience, assist in elective abortions.”  Severino concluded, “We stand ready to assist UVMMC in changing its policies and procedures to respect conscience rights and remedy the effects of its discrimination.” 

OCR is charged with helping ensure entities come into compliance with federal laws protecting conscience and prohibiting coercion in health care, including the Church Amendments.